Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $49.60 / $49.60 / $249.45	Facility	26	$49.60	$49.60	$249.45
Aetna Facility/Professional Professional Modifier Low / Median / High Price $168.59 / $269.39 / $472.00	Professional		$168.59	$269.39	$472.00
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $50.29 / $60.62 / $129.58	Professional	26	$50.29	$60.62	$129.58
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $111.85 / $186.91 / $318.95	Professional	TC	$111.85	$186.91	$318.95
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $39.03 / $54.73 / $118.60	Professional	26	$39.03	$54.73	$118.60
AmeriHealth Facility/Professional Professional Modifier Low / Median / High Price $82.65 / $82.65 / $82.65	Professional		$82.65	$82.65	$82.65
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $40.17 / $40.17 / $40.17	Facility	26	$40.17	$40.17	$40.17
Cigna Facility/Professional Professional Modifier Low / Median / High Price $154.87 / $332.49 / $574.59	Professional		$154.87	$332.49	$574.59
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $41.26 / $70.93 / $121.72	Professional	26	$41.26	$70.93	$121.72
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $110.60 / $260.87 / $458.63	Professional	TC	$110.60	$260.87	$458.63
Emblem Health Facility/Professional Professional Modifier Low / Median / High Price $201.71 / $267.52 / $806.48	Professional		$201.71	$267.52	$806.48
Emblem Health Facility/Professional Professional Modifier 26 Low / Median / High Price $64.93 / $75.84 / $103.65	Professional	26	$64.93	$75.84	$103.65
Emblem Health Facility/Professional Professional Modifier TC Low / Median / High Price $136.28 / $163.85 / $222.35	Professional	TC	$136.28	$163.85	$222.35
Horizon BCBS Facility/Professional Professional Modifier Low / Median / High Price $147.81 / $192.59 / $346.49	Professional		$147.81	$192.59	$346.49
Horizon BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $48.65 / $57.24 / $91.03	Professional	26	$48.65	$57.24	$91.03
Horizon BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $115.06 / $135.36 / $322.24	Professional	TC	$115.06	$135.36	$322.24
United Facility/Professional Professional Modifier Low / Median / High Price $152.80 / $266.32 / $434.12	Professional		$152.80	$266.32	$434.12
United Facility/Professional Professional Modifier 26 Low / Median / High Price $46.70 / $68.48 / $114.36	Professional	26	$46.70	$68.48	$114.36
United Facility/Professional Professional Modifier TC Low / Median / High Price $104.45 / $186.70 / $323.13	Professional	TC	$104.45	$186.70	$323.13